December, 2013 browsing by month


Male vs Female Sterilization: Which Partner Should Get It?

Monday, December 30th, 2013

Sterilization is a procedure for men and women that stops them from being able to conceive. It works by creating a barrier so that the egg and the sperm cannot meet. In women, the fallopian tubes are cut or sealed off to keep the egg from travelling into the uterus. In men, the vas deferens is cut and sealed off to keep the sperm from moving from the testicles into the penis. This is also called a vasectomy.  

As sterilization is permanent, it should be used only by couples who are completely sure that they will never want to have children, or who do not want to have any more children. When this is the case, sterilization offers a great solution – not having to worry about birth control ever again is a great thing. For many couples, the only real question they have about sterilization is: which partner should get it?

One significant issue is the fact that male sterilization is safer than female sterilization. At least 14 deaths are attributable to female sterilization in the US each year; in men, that number drops to zero. Complications are also less common with male sterilization. For many couples, this fact alone is enough to help them make up their minds. However, this is far from the only factor for most couples, and even though female sterilization comes with a few more (remote) risks than male sterilization, it is still extremely safe.

Couples should consider and discuss all of the factors involved in making this decision. Perhaps one partner has the time available to take off from work and recover properly. Perhaps one partner is deathly afraid of surgery while the other has no problem with it. Whichever partner is chosen for surgery should understand and be okay with the fact that this type of sterilization is permanent. Yes, there are reversal operations, but they are extremely expensive and often do not work.

Male Sterilization

Vasectomies are done using local anesthetic. The operation takes only about 15 minutes. The scrotum may be bruised, swollen, and painful for a week or so; wearing tight-fitting underpants helps with support. Strenuous exercise must be avoided for several weeks. Most men find that the pain they experience is very mild. Men can have sex as soon as the doctor gives the green light, which is usually as soon as it is comfortable. However, there may still be sperm in the semen for a while after the operation. Men must have a semen test eight weeks after surgery to make sure that the sperm are gone before having unprotected sex.

Female Sterilization

There are several different ways of blocking fallopian tubes: cutting, tying, clipping, and more. This may be done under general or local anesthetic. Because this is a more invasive procedure than is involved in male sterilization, and because it often involves general anesthesia, women may find that they feel uncomfortable and unwell overall for a few days. Women typically need to take it easy and get plenty of rest for a week or so. They may experience pain as well as slight vaginal bleeding. Women will need to continue to use contraception for several weeks after the surgery.

With either male or female sterilization, patients should follow the doctor’s instructions for post-surgery care. Patients should also understand that neither option is 100% effective, although 99.9% comes pretty close. Couples should discuss all of these issues and decide what is best for them.

– Yvonne S. Thornton, M. D., M. P. H.

Managing Urinary Incontinence

Thursday, December 26th, 2013

Urinary incontinence refers to the loss of bladder control and is a very common problem. Unfortunately, it is also a very embarrassing problem for many women, and so they often just live with it rather than discussing it with their doctors – which is too bad, because there are effective treatments available, and some of them are very simple.

Urinary incontinence can be mild or severe, ranging from the occasional leak upon sneezing or coughing to having such strong, sudden urges to urinate that you can’t make it to the toilet in time. If incontinence is affecting your day to day activities, please don’t hesitate to talk to your doctor about it. He or she has heard it before, and some simple medical treatment or even just lifestyle changes in some cases can make a huge difference. There are several different types of urinary incontinence, for example:

Stress Incontinence: Leaking urine when pressure is exerted on the bladder, such as through laughing, sneezing, coughing, or heavy lifting. Childbirth and menopause often result in stress incontinence. Obesity is a very common culprit.

Urge Incontinence: An intense and sudden need to urinate. Women with this type of incontinence often experience involuntary loss of urine and “not making it” to the toilet in time. The bladder contracts and in some cases the woman has only a matter of seconds to reach a restroom. This type of incontinence can be caused by a variety of health problems such as UTIs (urinary tract infections), stroke, Parkinson’s or Alzheimer’s disease, and multiple sclerosis. 

Overflow Incontinence: Women who have trouble emptying their bladders completely may experience overflow incontinence, or the frequent or constant leaking of urine. A women with this type of incontinence may not be able to empty her bladder and may be able to produce only a weak stream of urine; typically, this is caused by some type of damage to the bladder – for example, nerve damage caused by multiple sclerosis or diabetes.

There are also cases where women experience more than one type of incontinence. To be sure, it can feel embarrassing to tell your doctor you are having a problem with incontinence. But this is a much better option than suffering in silence. For starters, incontinence may be a symptom of a more serious problem. It can also seriously affect your quality of life, especially if you are restricting your activities and limiting social interactions.

What Causes Urinary Incontinence?

Incontinence can be temporary or permanent, mild or severe. It can be caused by a number of different things. Sometimes, temporary incontinence or isolated incidents can be caused by alcohol, caffeine, or over-hydration; it can also be caused by a UTI and in this case, it goes away as soon as the infection is treated.

When incontinence is persistent, it may be caused by an underlying physical condition or problem, such as an undiagnosed urinary tract infection , pregnancy, hysterectomy, neurological disorders, or obstruction of the urinary tract by a stone or tumor.  The most common reason is just aging and not pregnancy or the mode of delivery.   As stated here back in May, nuns have the same prevalence of urinary incontinence as mothers.


See Your Doctor for a Solution

Often, women with urinary incontinence are most comfortable talking to their gynecologists first. In most cases, your gynecologist can help you with this problem; in certain cases, he or she may need to refer you to a urogynecologist or other specialist. When you go to your appointment to discuss your problem, be prepared with some information that your doctor is sure to ask you for. For example, your symptoms in detail and a list of all medications you take (including vitamins). Also write down questions you have so you don’t forget them once you are in the doctor’s office.

The type of treatment recommended will depend on your individual symptoms and the type of incontinence you are experiencing. Your doctor will most likely suggest the least invasive treatments first, and often, these are quite effective. He or she may suggest that you try certain techniques such as bladder training, double voiding, diet and fluid management, or Kegel exercises.

If these are not effective, there are medications available that can help. There are also medical devices such as urethral inserts and pessaries that can be helpful. Sometimes, urinary continence may require surgical treatment.

To reduce your risk of developing urinary incontinence or to prevent yours from worsening, maintain a healthy weight, do regular Kegel exercises, don’t smoke, and avoid foods known to irritate the bladder such as caffeine and alcohol. You will almost certainly be glad that you talked to your doctor about your incontinence. Go make your appointment now and you’ll be one step closer to relief.

– Yvonne S. Thornton, M. D., M. P. H.

Preventing HPV Infection

Monday, December 23rd, 2013

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). HPV can lead to a number of serious health problems, such as genital warts and some types of cancer. Many people who have HPV do not know it, because it often causes no symptoms. HPV should not be confused with either herpes or HIV. While these can all be transmitted through sex, they cause different problems and produce different symptoms.

Anyone who has ever had sex has potentially been exposed to HPV. Remember – not everyone who has it is even aware they have it. At least half of all people who are sexually active will get HPV at some point. This statistic remains constant even in the case of people who have only one sexual partner in their entire lifetime.

Most commonly, HPV is transmitted through vaginal and anal sex. It does not discriminate between straight and homosexual couples. Furthermore, even if years have passed since contact with an infected person, HPV infection can still be present. In rare instances, HPV can be passed from a pregnant woman to her baby during delivery. In addition, one person can contract more than one type of HPV.

In most cases, HPV will go away on its own without causing any serious problems. Sometimes, however, the infection will stick around and cause serious issues such as genital warts, cervical cancer, or other types of cancer.

According to the CDC (Centers for Disease Control), HPV is the main cause of cervical cancer in women. There are about 12,000 new cervical cancer cases each year in the United States. Cervical cancer causes about 4,000 deaths in women each year in the United States. There are about 15,000 HPV-associated cancers in the United States that may be prevented by vaccines each year in women, including cervical, anal, vaginal, vulvar and oropharyngeal cancers.  In addition, about 7,000 HPV-associated cancers in the United States may be prevented by vaccine each year in men.  Approximately 1 in 100 sexually active adults in the United States have genital warts at any given time.


Should You or Your Daughter Get an HPV Vaccine?

Individuals can reduce their risk of getting HPV by getting vaccinated. As with any newer vaccine, there have been rumors regarding dangerous side effects. However, the fact is that the HPV vaccine has been shown to be safe and effective, and since at least 70% of all cervical cancers are caused by HPV, it is absolutely recommended that people who are able to get the vaccine do so. Gardasil is one vaccine that should be given to girls and young women between 11 and 26 years of age. Another available vaccine is Cervarix. The vaccines are given in the form of three doses (injections) administered over a period of six months; for the best protection, it is important to receive all of the doses (injections).

Sexually active individuals can also choose to lower their risk by using condoms. It is possible for HPV to affect areas that the condom does not cover, so realize that condoms are not 100% effective against the transmission of HPV. A vaccination is recommended even for people who always use condoms and plan to continue to do so.

Gardasil is also licensed, safe, and effective for males ages 9 through 26 years. CDC recommends Gardasil for all boys aged 11 or 12 years, and for males aged 13 through 21 years, who did not get any or all of the three recommended doses when they were younger. All men may receive the vaccine through age 26, and should speak with their doctor to find out if getting vaccinated is right for them.


The vaccine is also recommended for gay and bisexual men (or any man who has sex with men) and men with compromised immune systems (including HIV) through age 26, if they did not get fully vaccinated when they were younger.


Finally, limiting the number of sexual partners a person has can reduce their risk of being exposed to HPV; so can choosing a partner with few or no previous partners. But again, even if only have one sexual partner ever, you still have at least a 50% chance of contracting HPV – so, in you are in the appropriate age range, you should still receive the vaccine if possible.

– Yvonne S. Thornton, M. D., M. P. H.

Everything Old is New Again when it comes to Morning Sickness

Thursday, December 19th, 2013

Back in the 60s, and 70s, when I was a medical student, resident and perinatal Fellow, the drug of choice of morning sickness was Bendectin.  Bendectin, Bendectin, Bendectin.  It was prescribed like jellybeans to pregnant women in their first trimester to treat nausea and vomiting of pregnancy (morning sickness). It worked!!  I don’t think I would have gotten through my certification Boards without Bendectin when I was eight weeks pregnant with my daughter.

Then, all of a sudden, its was unceremoniously removed from the market and was unobtainable in 1983.  Why? Because the original manufacturer, Merrell Dow, could not continue to defend the lawsuits brought against the drug for supposedly causing birth defects.   After numerous horrific episodes of birth defects due to Thalidomide (which was not FDA approved in this country), women were quicker to blame medications taken during pregnancy for complications and birth defects.  Unfortunately, attorneys set their sights on Bendectin, which became the “whipping boy” for medications taken during early pregnancy and soon the mounting lawsuits (which were unfounded) resulted in its removal from the market.  In other words, this very effective medication was removed totally based on fear.

However, those of us who knew that the ingredients were just an antihistamine (doxylamine) and Vitamin B6 (pyridoxine), continued to direct our patients to the over-the-counter combination of Unisom and Vitamin B6.  In 2004, the American College of Obstetricians and Gynecologists sanctioned this jerry-rigged, improvised approach to “homemade” Bendectin as a first-line treatment for nausea and vomiting of pregnancy (morning sickness).

Well, thirty years later, a “new” drug, under a new manufacturer, called Diclegis (the brand name for doxylamine succinate and pyridoxine hydrochloride) was approved by the FDA earlier this year for use in pregnant women for the treatment of nausea and vomiting.  The drug is exactly the same as Bendectin.  However, this time, it has been categorized as Class A by the FDA, which means that there is no evidence that the drug causes birth defects in the human fetus.  With this FDA category of Class A, hopefully, it will reduce the threat of lawsuits.

As you are probably aware if you are or have been pregnant, so-called “morning” sickness can actually strike at any time of day, even lasting all day long in some cases. There are simple self-care strategies to try that are effective in many cases: avoiding fatty foods, eating smaller, more frequent meals, and avoiding smells that seem to trigger nausea. However, more often than not, these measures are not enough. Diclegis offers a welcome solution for many women.

Studies have shown Diclegis to be effective and safe. 261 women who had been pregnant for anywhere from seven to 14 weeks, were all 18 years old or older, and were all experiencing nausea or vomiting, were evaluated. In the study, there was more of a decrease in nausea and vomiting seen in women who took Diclegis than in women who took a placebo. The drug was also found to be completely safe for the fetus.

Women whose doctors prescribe Diclegis can expect to take two pills at night to start with. If this does not improve symptoms, the dose can be increased to a total of four pills per day (one in the morning, one in the afternoon, and two at night). Drowsiness is among the possible side effects (because of the antihistamine), so women who take the drug should not drive. If you have questions about Diclegis or need further information on morning sickness, see my book, Inside Information for Women, and talk to your doctor. He or she can help you decide if Diclegis is the right choice for you.

Pregnant women who suffer from morning sickness may be worried that their babies aren’t getting enough nutrition, but in most cases, there is no cause for concern. The caloric needs of a fetus are tiny, especially in the first trimester, when the majority of morning sickness occurs. Occasionally a woman develops hyperemesis gravidarum, which is a very severe form of morning sickness in which she may not even be able to keep water down and may need to be hospitalized. Diclegis has not been tested on women with this form of severe nausea and vomiting.

– Yvonne S. Thornton, M. D., M. P. H.

Women with High Blood Pressure Who Smoke Have Greater Risk of Aneurysm

Monday, December 16th, 2013

Subarachnoid hemorrhage (SAH) is a cerebrovascular catastrophe that kills 40 to 50 percent of sufferers. A ruptured intracranial aneurysm is the most common cause of SAH. Sometimes, aneurysms are found and treated before they have a chance to rupture. Furthermore, some aneurysms will never rupture. However, there is no way to tell which ones will and which ones won’t. In addition, research now shows that women who smoke and have high blood pressure are more likely to develop SAH. Twenty times more likely!

This discovery is important because it sheds some light on how to decide whether to treat a person with an unruptured intracranial aneurysm. If we know that a female patient with high blood pressure who smokes is significantly more likely to develop SAH than a male patient with normal blood pressure who doesn’t smoke, and intracranial aneurysms are found in both, then it may be that the woman needs to be treated while the man does not. This is an important step in being able to predict which aneurysms are likely to rupture and which aren’t.

The study also revealed three previously unknown risk factors for SAH: elevated cholesterol levels in men, and maternal history of stroke and previous heart attack in either gender. These results show that the risk factors for SAH appear to be similar to the risk factors for other cardiovascular diseases.

It is already known that lifestyle risk factors have a significant impact on the life expectancy of a person who has survived SAH. Now, it is becoming clear that those same risk factors increase the risk of SAH in the first place. Therefore, quitting smoking and taking steps to lower high blood pressure are especially important in both preventing SAH and increasing life expectancy if it does occur.

Of course, this is just one more item to add to the list of reasons why you should quit smoking. Smoking is a well-known health risk that people can choose not to expose themselves to. Cigarettes contain over 4000 chemicals, at least 400 of which are known toxic substances.

Among the most harmful products in cigarette smoke are tar, which is a carcinogen; nicotine, which is addictive and is thought to increase cholesterol levels and carbon monoxide, which replaces oxygen in your bloodstream. An individual’s overall health risk from smoking depends upon a number of factors, including how much the individual smokes, whether the cigarette has a filter, and how the tobacco has been prepared. More research is needed before it will be clear whether these same factors affect a person’s SAH risk.

As for hypertension, it is known to be potentially damaging to several body systems, including the arteries, heart, brain, and kidneys. Talk to your doctor about your blood pressure and/or smoking to find solutions for lowering your blood pressure, helping you quit smoking, or both.

– Yvonne S. Thornton, M. D., M. P. H.

Diagnosing Menopause

Thursday, December 12th, 2013

Thousands of women enter menopause each day. With average life expectancy increasing, the average woman will live out a third of her life after menopause. Menopause begins anywhere between 48 and 55 years old, but the average is 52. What does it mean to enter menopause, though, and what changes lead up to the official beginning of menopause?

Estimating when menopause will begin is more important than simply predicting the final menstrual period (FMP). In the year leading up to this, bone loss accelerates and cardiovascular risk factors increase. Until fairly recently, there was no reliable way to predict when the FMP would occur. Now, we are beginning to learn ways to estimate whether a woman is within a year or two of her FMP. These models are not used in clinical settings yet, but work in this area is promising.

Perimenopause begins several years (four, on average) before menopause. This is a transitional stage that includes several physiologic changes, including:

1. Irregular menstrual periods. A woman’s menstrual cycle undergoes marked changes in the years leading up to menopause. Typically this is a gradual lightening and spacing out of periods, but it can include heavier, more frequent periods, or sporadic combination of both.  

2. Hot flashes. Hot flashes are an extremely common symptoms of menopause, occurring in up to 80 percent of women.  These generally last several minutes and are characterized by a sudden sensation of heat that spreads out from the chest and face. Sweating and heart palpitations can accompany hot flashes, which are sometimes followed by feeling cold and shivering. Hot flashes may occur less often than daily, or they may occur several times in one day. They happen particularly often at night.

3. Sleep disturbances. Sometimes, hot flashes cause sleep problems, but often, sleep problems occur even without hot flashes. Feelings of anxiety or depression may contribute to sleep disturbances.

4. Vaginal dryness. As estrogen decreases, the vaginal lining thins, resulting in atrophic vaginitis, which can cause vaginal dryness, itching, and dyspareunia (painful intercourse) due to insufficient natural lubrication. A water-based lubricant can easily solve this problem.

5. Depression. Perimenopausal women are more likely to experience depression than premenopausal women, and sometimes this is new-onset depression. Then, in early postmenopause, the risk decreases.

Other symptoms can be present during the menopausal transition, including problems with sexual function, cognitive changes such as memory loss or difficulty concentrating, joint aches and pains, breast tenderness, headaches, and long-term issues such as bone loss and the increased risk of cardiovascular disease. A woman may experience only one or two menopausal symptoms or she may get every symptom in the book.

After several years of menstrual irregularity, menses eventually ceases altogether. Clinical menopause is defined as the absence of menstrual periods for at least six months. All of the symptoms of menopause can be treated and quality of life improved. Talk to your doctor about treatments for individual symptoms, or the possibility of hormone replacement therapy. You can also find more information on this topic in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Obsessive-Compulsive Disorder and Pregnancy

Monday, December 9th, 2013

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by unwanted, recurring thoughts or fears (obsessions) and the behaviors a person develops to try and stop the fears from coming true (compulsions). People with OCD get into cycles of obsessive thoughts which are followed by compulsive behaviors. The compulsive behavior brings temporary relief from the anxiety, but only temporary. Soon the obsession and its accompanying anxiety return, and the cycle starts all over.

For example, a person might repeatedly wash his or her hands, clean the house, or check things such as locks or light switches. Sufferers are aware that there is no need for the behavior, but they are unable to stop themselves from repeating it. OCD can be very time-consuming and cause more anxiety or stress, rather than reliving it. In severe cases, it can stop people from leading normal lives.

Pregnancy and OCD have a relationship that is not yet well understood. Sometimes, a woman experiences OCD for the first time during pregnancy or following childbirth. Also, some women who have existing OCD may find that their symptoms worsen during pregnancy or in the weeks or months following childbirth. Still other women find that their symptoms improve during pregnancy.

OCD and depression are commonly found together; new mothers with OCD may be more likely to experience postpartum depression, or they may experience postpartum depression that is more severe. Among the general population, OCD is thought to affect about one in 100 people; about twice that number are affected during pregnancy and after childbirth. 

How Do You Know if You Have OCD?

Worries and fears are normal and common among pregnant women or new mothers. Such thoughts and fears usually do not signal OCD. However, OCD could be a concern if the anxiety is overwhelming or if it leads to needless and repetitive behaviors.

Fears that the baby is in some kind of danger are common among pregnant women with OCD. A woman may be afraid that she will somehow harm her baby herself, and therefore develop compulsions to try to protect her baby. For example, she may stop eating certain foods she believes may harm her unborn baby, even if her doctor says they are safe to eat. Or, after the baby is born, the new mother may compulsively check on the sleeping baby. She may constantly clean areas the baby has contact with, or she may even avoid spending time with her baby.

Why Is OCD More Common During Pregnancy?

The reason for this is not fully understood. Often, the reason for OCD cannot be pinpointed, even when pregnancy is not a factor. In some cases, it could be that new mothers feel the added pressure of the extra responsibility having a new baby places on them. Or, it may be that a mother suppresses negative emotions because she is “supposed” to be experiencing a joyful event. It is also possible that changes in brain chemistry play a role, or that hormonal fluctuations have an effect.

If you think you may have OCD, ask your doctor about it. He or she can refer you to someone who is trained to help people with OCD. Talking to someone who understands what you are going through is usually very helpful.

– Yvonne S. Thornton, M. D., M. P. H.

Gynecologists and Male Patients?

Thursday, December 5th, 2013

Gynecology is, by definition, the branch of medicine that deals with functions and diseases, especially of the reproductive system, specific to women and girls. However, recently, some gynecologists have been looking at this definition as more of a recommendation – and a flexible one at that. For example, a gynecologist at Boston Medical Center has added a new demographic to her patient roster: men.

Dr. Stier and other gynecologists who share her views have started caring for certain men; specifically, those at high risk for anal cancer. Anal cancer is rare, but it can be fatal and it is being seen more frequently, particularly among men and women who are HIV positive. Anal cancer is typically caused by the human papillomavirus (HPV) virus – the same virus that is often blamed for cervical cancer.

Dr. Stier sees mostly women, but last year she treated about 110 men as well. Using techniques she adapted from the ones developed to screen women for cervical cancer, she began screening men for anal cancer.

However, in September, the American Board of Obstetrics and Gynecology mandated that its members limit their practice to women with very few exceptions. In addition, they said that gynecologists were not allowed to perform the procedure Dr. Stier had been performing on men. Gynecologists, who often need their board certification to keep their jobs, cannot ignore directives like this.

Now Dr. Stier’s male patients are upset and her studies are in limbo. And she is not alone – other gynecologists who were engaging in the same practices have found themselves in similar circumstances. Researchers and doctors have asked the board to reconsider, but so far the board will not, pointing out that there are other doctors who could perform the screening procedures on men. The board also reiterates that the field of gynecology was specifically designed to treat women.

Apparently, Dr. Stier and others had not understood how absolute the definition of the field of gynecology was. But the board has drawn the line, emphasizing that its mission is treating women, not dabbling in spin-offs for their potential profitability. The screening process used by Dr. Stier, anoscopy, is not the only procedure in question nor is this the only incident of gynecologists straying from the original framework of gynecology; others had begun providing treatments such as testosterone therapy for men and cosmetic procedures such as liposuction for both men and women.

This trend is changing, however, thanks to the new rules the board posted on its website on September 12.  The new rules are explicit, specific, and outline exactly what gynecology should entail: treatment of women, with treatment of male patients limited to very specific circumstances, such as fertility evaluation, newborn circumcision, and emergency care.

Some doctors are upset by the new guidelines, including Dr. Stier, who is concerned that her male patients won’t get the follow-up they need now that she can no longer see them. However, there is no reason that I can see why the specialty of gynecology should expand into unrelated disciplines. The very reason why we have specialties is so that specific areas of medicine can be studied thoroughly and the treatments we are able to provide kept up to the minute. A gynecologist should specialize in gynecology – delivering babies, taking care of women. Other practices and treatments are important and helpful, but they aren’t gynecology.

– Yvonne S. Thornton, M. D., M. P. H.

The Importance of Breast Self-Exams

Monday, December 2nd, 2013

Breast cancer is a major topic of interest these days, partly because so many women will eventually get it, and partly because education can make such a huge difference in a given woman’s prognosis. According to the National Cancer Institute, the 5-year survival rate ranges from 98% when the cancer is caught early and has not metastasized to around 24% when it not found until after it has already spread to other parts of the body. This is precisely why screening measures such as breast self-exam, clinical exams by a doctor, and regular mammograms after age 40 are so important.

Breast Self-Exam

Self-exam is the most important and most effective screening method available to women younger than 40 years of age. It is free, takes very little time, and saves thousands of lives every year. No one is as familiar with your own unique breasts as you are, so you can often find changes, thickening, lumps, or skin changes that other people might not notice during an examination.

Examine your breasts during the same time each month – for example, ten days after your period starts. If that is too hard to keep track of, then do the exam on the last day of your period. Before or during your period is not a great time because your breasts may be enlarged, making it hard to determine what you are feeling.

Look at your breasts in the mirror, checking for symmetry. If one of your breasts has always been slightly larger than the other, then this is nothing to worry about. However, if one of your breasts has newly become larger than the other, this is something to get checked out. Look for any changes in the skin, such as dimpling, pitting (like an orange peel), or redness. Look for any retraction of the skin that occurs when you raise your arms above your head.

To feel for lumps or changes inside your breasts, the best place is in the shower because your hands slide more easily over wet, soapy skin. Use your fingers to make concentric circles all over your breast, working your way in toward the nipple, and checking for any unusual lumps and also squeezing the nipple to check for any discharge (there should be none unless you are lactating). Don’t forget to check your armpit for lumps as well. After your shower, repeat this exam lying on your back with your arm raised above your head and lotion or baby oil on your skin.

Why Is Breast Self-Exam Important?

In just a few minutes once a month, you could very well save your own life. Women have many reasons for not performing self-exams. They may be afraid of what they will find (ironically, breast self-exams keep women much safer). They may not think it necessary, since their doctors examine their breasts (but a tumor can do a lot of spreading in a year’s time). Or they may forget or not think about it for months at a time. However, the statistics show the importance of making an effort to remember this.

Clinical screening methods are also important and can catch things that a woman might not be able to feel or see in her own breasts. An annual exam by your gynecologist as well as regular mammograms are important screening tools that save many lives – but neither is as effective or as important as being familiar enough with your own breasts to be aware of a change the moment it happens. If you do feel or see a change in one of your breasts, but your doctor seems to think it’s nothing, don’t worry – he or she is probably right – but do insist on following up with a mammogram to take another look. No one knows your body like you do. You are the expert on your unique body, you are the one responsible for your own well-being, and you are the one in charge of watching for signs of breast cancer and getting medical attention immediately if they do appear.

If you are older than 40 years of age, then a mammogram is the preferred approach to evaluation of your breast (perhaps with an adjunctive sonogram for dense breasts).  A Canadian Task Force concluded that breast self-examination in older women (40-69 years) )should not be performed due to increased anxiety and unnecessary biopsies for benign disease.  However, as I have stated in my women’s health book, “Inside Information for Women”, I believe that breast self-examination has the potential to detect breast cancer that you can feel and still should be recommended.

– Yvonne S. Thornton, M. D., M. P. H.